How to Apply

Our intent is to help young adults between the ages of 18-24 that are currently being treated or have finished treatment within the last year.  Applications are accepted on a rolling basis.  Applications can be submitted by recipient or someone connected.  Applications can be submitted electronically using the ‘Online Application’ button below OR download the application (pdf) and send via email or to the mailing address provided on the application.  

Eligibility Guidelines:

You must be:

Between the ages of 18-24.

Diagnosed with cancer and currently undergoing treatments or treated within the past year.

Print or type your information on the application so it is easy to read.
If you have any questions please contact us at
Contact name, Beth Shumaker or call 607-222-9341.

Online Application

We are currently assisting young adults with all types of cancer, ages 18-24 years old. Application can be completed by recipient or someone connected. Please fill out the information below.